Goljy Female Reproductive. Flashcards
1
Q
MCCC bartholin gland abscess
A
neisseria gonorrhea
2
Q
thinning of epidermis of vulva in post-menopausal women resulting in parchment-like appearance of skin
A
lichen sclerosis
3
Q
white plaque like lesion on vulva due to squamous cell hyperplasia
A
lichen simplex chronicus
4
Q
benign tumor of apocrine sweat gland forming a painful nodule on labia majora
A
papillary hidradenoma
5
Q
vulvar intraepithelial neoplasia
A
associated with HPV 16 –> precursor for developing squamous cell carcinoma
6
Q
MC malignancy of vulva
A
squamous cell carcinoma
7
Q
risk factors for squamous cell carcinoma of vulva
A
HPV 16, smoking, immunodeficiency
8
Q
red, crusted vulvar lesion that is a type of intraepithelial adenocarcinoma with PAS+ cells that spreads along the epithelium, rarely invading the dermis
A
extramammary Paget’s disease
9
Q
which other type of cells histologically resemble paget’s cells?
A
melanoma cells –> but they are PAS negative
10
Q
an anatomic cause of primary amenorrhea, with absence of the upper vagina and uterus?
A
Rokitansky-Kuster-Hauser syndrome
11
Q
a remnant of the the Wolffian (mesonephric) duct that presents as a cyst on the lateral wall of vagina
A
Gartner’ duct cyst
12
Q
benign tumor of skeletal muscle that can be found in vagina, tongue or heart?
A
rhabdomyosarcoma
13
Q
grape-like mass protruding from the vagina in young girls (
A
embryonal rhabdoymyosarcoma aka. sarcoma botyroides
14
Q
which cancer occurs in women with intrauterine exposure to diethylstilbestrol?
A
clear cell adenocarcinoma of vagina
15
Q
red, superficial ulcerations in upper vagina due to remnants of mullerian glands
A
vaginal adenosis –> precursor lesion for clear cell adenocarcinoma
16
Q
besides clear cell carcinoma, what are some other abnormalities caused by DES?
A
abnormally shaped uterus that thwarts implantation; cervical incompetence - recurrent abortions
17
Q
transformation zone in cervix
A
site where squamous dysplasia and cancer develop –> site sampled during a PAP smear
18
Q
nabothian cysts
A
obstruction of outflow of mucus from endocervical glands due to blockage by metaplastic squamous cells
19
Q
causative agents of acute cervicitis
A
Chlamydia and Neisseria gonorrhea = > 50% of cases, trichomonad vaginalis, candida, herpes simplex virus (HSV2), HPV
20
Q
clinical findings in acute cervicitis
A
vaginal discharge - MC, pelvic pain, dyspareunia, painful on palpation, bleeds easily during cultures, cervical os is erythematous and covered by exudate
21
Q
follicular cervicitis
A
C.trachomatis infects metaplastic squamous cells - cells contain vacuoles w/ red inclusions (reticulate bodies) which develop into elementary bodies (infective particles)
22
Q
primary source of conjunctivitis and pneumonia in newborns?
A
Chlamydia trachomatis cervicitis
23
Q
purpose of PAP smear
A
screen test to R/O squamous dysplasia and cancer, evaluates the hormone status of patient
24
Q
superficial squamous cells on Pap smear
A
adequate estrogen, - 100% of these cells in women with continuous exposure to estrogen without P4
25
intermediate squamous cells on Pap
adequate progesterone - 100% of these cells seen in pregnant women
26
parabasal cells on Pap smear
lack of estrogen and P4 - usually in elderly women
27
non-neoplastic polyp that protrudes from endocervix on cervical os commonly seen in perimenopausal and multigravida women between age 30-50
cervical polyp - not precancerous
28
clinical findings with a cervical polyp
postcoital bleeding; vaginal discharge
29
koilocytosis
clear halo containing a wrinkled, pyknotic nucleus --> effect of HPV on squamous cells
30
risk factors for cervical intraepithelial neoplasia (CIN)
early age at onset of sexual intercourse; multiple, high risk partners; HPV 16, 18; smoking, OCPs, immunodeficiency
31
CIN 1
mild dysplasia involving the lower 1/3 of epithelium
32
CIN 2
moderate dysplasia involving lower 2/3 of epithelium
33
CIN 3
severe dysplasia --> carcinoma in situ involving the full thickness of epithelium
34
appearance of CIN on colposcopy
acetowhite areas with punctuation, mosaic pattern or abnormal vascularity
35
what type of cancer is cervical cancer?
mostly squamous cell carcinoma --> small cell and adenocarcinoma are less common
36
clinical findings in cervical cancer
abnormal vaginal bleeding - esp. post coital; malodorous discharge
37
MCC of death in cervical cancer
postrenal azotemia causing renal failure
38
sequence to menarche
breast budding, growth spurt, pubic hair, axillary hair, menarche
39
proliferative phase of menstrual cycle
follicular phase --> estrogen mediated, most variable phase
40
secretory phase of menstrual cycle
luteal phase --> progesterone mediated, increased pland turtuosity, edema of stromal cells
41
Arias-Stella phenomenon
exaggerated secretory phase that occurs in pregnancy
42
what initiates menses?
drop in serum levels of estrogen and P4 if fertilization does not occur --> plasmin prevents menstrual blood from clotting
43
functions of FSH (3)
1. prepares follicle 2. aromatase synthesis in granulosa cells 3. synthesis of LH receptors
44
functions of LH in proliferative phase
increases synthesis of 17-ketosteroids in theca interna to synthesize testosterone for conversion by aromate to estradiol in granulosa cells
45
functions of LH in secretory phase
theca interna synthesizes 17-OH progesterone
46
functions of hCG
synthesized by syncitiotrophoblast and acts as an LH analogue by maintaining the corpus luteum during pregnancy
47
primary estrogen in non-pregnant women
estradiol
48
estrogen of postmenopausal women
estrone --> derived from adipose cell aromatization of androstenedione
49
primary estrogen of pregnancy
estriol --> from fetal adrenal, placenta and maternal liver
50
androstenedione
derived from ovaries and adrenal cortex
51
DHEA
mainly synthesized in adrenal cortex (remainder in ovaries)
52
DHEA-sulfate
made exclusively in the adrenal cortex
53
where is testosterone made?
synthesized in ovaries and adrenal glands
54
definition: menopause
no menses for 1 year after age 40
55
causes of menopause
physiologic, surgical removal/radiation of ovaries, Turner’s syndrome, family history of early menopause, left-handedness
56
clinical findings in menopause
secondary amenorrhea; hot flushes, night sweats, atrophic veginitis; mood swings, anxiety, depression, insomnia, decreased libido, urinary incontinence, headaches, tiredness, lethary, osteoporosis
57
best marker for menopause
serum FSH --> increased
58
excess hair in normal hair-bearing sites
hirsutism
59
hirsutism + male secondary sex characteristics
virilization
60
male secondary sex characteristics
increased muscle mass, acne, enlarged clitoris --> most impt finding
61
cause of hirsutism/virilization
hyperandrogenicity of ovarian, adrenal or drug origin
62
MCC of hirsutism
polycystic ovary syndrome
63
an obese female presents to you with hirsutism, oligomenorrhea and questions her fertility -- most probable diagnosis?
PCOS
64
lab findings in PCOS
LH:FSH ratio > 2; increased serum testosterone and androstenedione; increased serum estrogen
65
women with PCOS have an increased risk for..
endometrial cancer
66
treatment of PCOS
weight reduction, low dose OCPs or medroxyprogesterone, spironolactone is OCPs unacceptable, LH-releasing hormone analogues
67
menorrhagia
loss of > 80 ml of blood per period --> likely if staining sheets at night with heavy protection and excessive passage of clotsp
68
primary dysmenorrhea
painful menses that occurs only in ovulatory cycles due to increased PGF2 which increases uterine contractions
69
secondary dysmenorrhea
painful menses due to endometriosis (MC), adenomyosis, leiomyomas and cervical stenosis
70
metorrhagia
excessive flow and duration at irregular intervals
71
oligomenorrhea
intervals > 35 days
72
polymenorrhea
intervals
73
90% of abnomal bleeding is caused by...
anovulation --> majority of cases are postmenarchal and perimenopausal (MC)
74
MCC of anovulatory dysfunctional uterine bleeding
excessive estrogen stimulation in relation to P4 = absent secretory phase of cycle, producing endometrial hyperplasia and excessive bleeding
75
causes of ovulatory dysfunctional uterine bleeding
(1) inadequate luteal phase (decreased P4) (2) irregular shedding of endometrium (persistent luteal phase)
76
absence of menses by age 16
primary amenorrhea
77
absence of menses for 3 months
secondary amenorrhea --> usually due to pregnancy
78
primary amenorrhea + poor female secondary sex characteristics
probable Turner's syndrome
79
Asherman syndrome
removal of stratum basalis owing to repeated curretage --> caused of end-organ defect amenorrhea
80
uterine infection following delivery (vaginal/cesarean section) or abortion usually caused by group B streptococcus
endometritis
81
patient who just delivered a baby presents to you with fever, uterine tenderness, foul vaginal discharge and abdominal pain - diagnosis?
endometritis
82
treatment of endometritis
cefoxitin, ticarcillin-clavulanate, ampicillin-sulbactam
83
causes of chronic endometritis
retained placenta, gonorrhea, intrauterine device - actinomyces israelii
84
key histologic finding for chronic endometritis on biopsy
presence of plasma cells
85
invagination of stratum basalis into the myometrium with glands and stroma present in the myometrium producing uterine enlargement
adenomyosis
86
clinical findings in adenomyosis
menorrhagia, dysmenorrhea, pelvic pain
87
functioning glands and stroma located outside the uterus
endometriosis
88
pathogenesis of endometriosis
1. reverse menses through fallopain tubes w/ implantation of viable endometrial cells 2. coelemic metaplasia 3. vascular or lymphatic spread
89
common sites for endometriosis
ovaries, rectal pouch of douglas, fallopian tubes, intestine
90
rectal pouch of Douglas
anterior to rectum and posterior to uterus --> can be palpated on DRE in females --> site for collection of blood, malignant cells, pus and endometrial implants
91
clinical findings in endometriosis
dysmenorrhea, menorrhagia, painful stooling during menses, infertility, dyspareunia, increased risk of ectopic pregnancy, enlargement of ovaries with blood-filled cysts
92
common cause of menorrhagia in 20-40 year olds with spotting between menstrual periods or after menopause
endometrial polyp - - benign, enlarged with estrogen stimulation
93
risk factors for endometrial hyperplasia
1. early menarche, late menopause 2. nulliparity
3. obesity
4. PCOS
5. estrogen replacement therapy
6. anovulatory menstrual cycles
7. HNPCC
94
clinical findings in endometrial hyperplasia
postmenopausal bleeding
95
MC gynecologic cancer
endometrial carcinoma
96
risk factors for endometrial carcinoma
prolonged estrogen stimulation, OCPs decrease risk due to opposing effect of progestin
97
adenoacanthoma
endometrial adenocarcinoma that contains foci of benign squamous tissue (no prognostic significance)
98
adenosquamous carcinoma
endometrial adenocarcinoma with foci of malignant squamous cells (worse prognosis)
99
papillary adenocarcinoma
highly aggressive form of endometrial cancer
100
most common finding in endometrial carcinoma
postmenopausal bleeding
101
MC benign CT tissue tumor in women
leiomyoma "fibroids"
102
clinical findings in leiomyoma
menorrhagia, obstructive delivery,
pressure on colon = constipation,
pressure on bladder = urgency, frequency, incontinence
103
MC sarcoma of the uterus
leiomyosarcoma --> numerous atypical mitoses and foci of necrosis
104
malignant mixed mullerian tumor (Carcinosarcoma)
endometrial adenocarcinoma + malignant mesenchymal (stromal) tumor - bulky, necrotic tumors that often protrude through cervical os
105
carcinosarcomas are associated with..
previous irradiation
106
cystic Mullerian remnants located around the fimbriated end of fallopian tube which may undergo torsion causing abdominal pain
hydatid cysts of Morgagni
107
MCC of ectopic pregnancy and female infertility
pelvic inflammatory disease
108
risk factors for PID
multiple sexual partners, vaginal douching,
previous episodes of PID,
unprotected sex
109
MC pathogens causing PID
chlamydia trachomatis, neisseria gonorrhea
| - in 45% of cases the is co-infection
110
clinical findings in PID
fever, lower abdominal pain;
cervical motion, adnexal and uterine tenderness;
abnormal uterine bleeding/discharge;
mucopurulent discharge
111
Fitz-Hughes-Curtis syndrome
perihepatitis --> PID extends to infect liver capsule producing RUQ pain
112
treatment of PID
ceftriaxone + doxcycline
113
invagination of the mucosa of fallopian tube into the muscle (tubal diverticulosis) that produces nodules in the tube that narrow the lumen
salpingitis isthmica nodosa
114
women presents to you with vaginal bleeding, suddent onset pelvic pain and an adnexal mass - most likely diagnosis?
ectopic pregnancy
115
implantation of fetus in abnormal location occuring in 1-2% of pregnancies
ectopic pregnancy
116
risk factors for ectopic pregnancy
MCC = scarring from PID, endometriosis,
altered tubal motility,
progestin only pill,
previous tubal ligation
117
clinical findings in ectopic pregnancy
sudden onset of lower abdominal pain and tenderness - usually 6 weeks after normal menstrual period, adnexal tenderness,
rebound tenderness,
abnormal uterine , bleeding
hypovolemic shock
118
MCC of death in early pregnancy
ectopic pregnancy rupture with intra-abdominal bleed
119
screening and confirmatory tests for ectopic pregnancy
urine B-hCG
120
accumulation of fluid in a follicle or previously ruptured follicle
follicular cyst = MC ovarian mass
121
accumulation of fluid in corpus luteum during pregnancy that may be mistaken for an amniotic sac and usually regresses on its own
corpus luteum cyst --> MC ovarian mass in pregnancy
122
bilateral ovarian enlargement due to hypercellular ovarian stroma seen in obese post-menopausal women
stromal hyperthecosis
123
clinical findings in stromal hyperthecosis
hirsutism/virilization, acanthosis nigricans and insulin resistance,
hypertension
124
treatment of stromal hyperthecosis
oophorectomy
125
OCPs and pregnancy as risk factors for ovarian cancer
decrease risk of surface-derived ovarian tumors due a decreased number of ovulatory cycles
126
MC group of ovarian tumors
surface derived ovarian tumors --> Derived from coelomic epithelium and commonly seed the omentum
127
MC benign and malignant germ cell tumors
benign = teratoma; malignant = dysgerminoma
128
sex cord stromal tumors
hormone producing tumors derived from stromal cells- usually benign
129
MC sign of ovarian tumor
abdominal enlargement due to fluid --> malignant ascites, palpable ovarian mass in post-meno women,
malignant pleural effusion,
radiographs showing bones or teeth,
signs of hyperestrinism - bleeding, 100% superficial squamous cells on Pap smear
130
tumor markers for ovarian tumors
CA125 --> only increased in surface derived ovarian tumors
131
large multiloculated ovarian tumors lined by mucus-secreting cells whose seeding produces pseudomyxoma peritonei
mucinous ovarian tumors
132
mucinous cystadenoma may be associated with...
Brenner tumors
133
bilateral malignant ovarian tumors associated with endometrial carcinoma
endometroid tumors
134
MC benign germ cell tumor
cystic teratoma
135
Rokitansky tubercle
nipple like structure in the cyst wall of a cystic teratoma that contains all of the germ layer derivatives
136
MC malignant germ cell tumor
dysgerminoma
137
ovarian tumor characterized by an increase in LDH with the same picture as seminoma of testes; associated with streak gonads of Turner's syndrome
dysgerminoma
138
MC ovarian cancer in girls
yolk sac tumor
139
benign tumor associated with Meig's syndrome (Ascites, R-sided pleural effusion) that commonly calcifies
thecoma-fibroma
140
low grade malignant feminizing tumor (produces estrogen) that contains Call-Exner bodies
granulosa-theca cell tumor
141
benign masculinizing tumor that produces androgens and may contain crystals of Reinke
sertoli-leydig tumor
142
malignant tumor with mixture of germ cell tumors (dysgerminoma) and sex-cord stromal tumor associated with abnormal sexual development and commonly calcifies
gonadoblastoma
143
tumor containing signet-ring cells from hematogenous spread of a gastric cancer
Krukenberg tumor
144
fetal surface of placenta
chorionic plate -- chorionic villi vessels converge with the umbilical cord; the chorion is covered by the amnion
145
maternal surface of placenta
decidua basalis forms cotyledons
146
what does the umbilical cord contain?
two umbilical veins (carry oxygenated blood), one umbilical artery (carries deox blood)
147
MC pathogen of placental infections
group B strep --> treat with penicillin G or IV ampicillin
148
infection of umbilical cord
funisitis
149
chorioamnionitis
infection of fetal membranes with danger of neonatal sepsis and meningitis
150
pregnant women presents to you with painless vaginal bleeding in her third trimester.. what can you suspect?
placenta previa --> DO NOT do pelvic exam - diagnose via USG
151
pregnant women in her third trimester presents to you with painful vaginal bleeding, forceful uterine contractions and signs of preterm labor; fetal distress is noted -- diagnosis?
abruptio placentae
152
retroplacental blood clot that seperates the placenta prematurely from its implantation site
abruptio placentae
153
MCC of painful late pregnancy bleeding
abruptio placentae
154
direct implantation of fetus into myometrium due to defective decidual layer which poses a great risk for hemorrhage during delivery
placenta acreta
155
velamentous insertion
umbilical cord inserts away from the placental edge - danger of tearing vessels during delivery (usually delivered by c-section)
156
causes of an enlarged placenta
Diabetes Mellitus, Rh hemolytic disease of newborn,
| congenital syphillis
157
risk factors for pre-eclampsia
(1) age 35 yo (2) history of previous preeclampsia
(3) positive family history
(4) blacks
(5) multiple gestations
(6) thrombocytosis
(7) obesity
158
pathogenesis of pre-eclampsia
abnormal placentation with decreased vasodilators and increased vasoconstrictors leading to net effect of placental hypoperfusion
159
pathologic findings in pre-eclampsia
premature aging of placenta, multiple placental infarctions,
| spiral arteries show intimal atherosclerosis
160
preeclampsia + seizures
eclampsia
161
clinical findings in preeclampsia
hypertension, proteinuria in nephrotic range,
pitting edema,
weight gain > 4 lbs/week,
generalized seizures,
renal disease - swollen endothelial cells, oliguria,
RUQ pain and hepatomegaly
162
HELLP syndrome
Hemolysis, Elevated LFTs,
Low Platelets,
--> hemolytic anemia and DIC
163
benign tumor of chorionic villus
hydatidiform mole
164
patient presents to you in 4th or 5th month of pregnancy with painless vaginal bleeding and severe vomiting, you notice her uterus is too large and her hCG levels are too high for gestational age
complete hydatidiform mole
165
USG appearance of complete hydatidiform mole
snow storm appearance with no fetus during 1st sonogram
166
complete hydatidiform mole
entire placenta is neoplastic with dilated, swollen villi without fetal blood vessels; no embyro is present
167
treatment of complete hydatidiform mole
dilation and curretage --> must remove all material
168
malignant tumor composed to syncitiotrophoblast and cytotrophoblast with the absence of chorionic villi
choriocarcinoma
169
risk factors for choriocarcinoma
complete mole, spontaneous abortion,
| normal pregnancy
170
causes of polyhydraminos
tracheoesophageal fistula, duodenal atresia,
maternal diabetes - fetal polyuria,
anencephaly
171
causes of oligohydraminos
juvenile polycystic kidney disease, fetal genitourinary obstruction,
ureteroplacental insufficiency,
premature rupture of membranes
172
increased maternal AFP in pregnancy
open neural tube defect
173
decreased maternal AFP in pregnancy
Downs
174
lecithin:sphinomyelin ratio that indicated adequate surfactant
L:S ratio > 2
175
which hormones can be given to mom to increase surfactant synthesis in baby?
cortisol, thyroxine
176
which hormones inhibit surfactant synthesis in baby?
insulin
177
decreased levels of estriol in pregnancy
sign of fetal-maternal-placental dysfunction
178
triple screen in Down's syndrome
decreased urine estriol, decreased serum AFP,
| increased serum B-hCG
